Effects of Preoperative Motor Status on Intraoperative Motor-evoked Potential Monitoring for High-risk Spinal Surgery

被引：12

作者：

Kobayashi, Kazuyoshi ^{[1
,2
]}

Imagama, Shiro ^{[1
,2
]}

Yoshida, Go ^{[2
,3
]}

Ando, Muneharu ^{[2
,4
]}

Kawabata, Shigenori ^{[2
,5
]}

Yamada, Kei ^{[2
,6
]}

Kanchiku, Tsukasa ^{[2
,7
]}

Fujiwara, Yasushi ^{[2
]}

Taniguchi, Shinichirou ^{[2
,4
,8
]}

Iwasaki, Hiroshi ^{[2
,9
]}

Tadokoro, Nobuaki ^{[2
,10
]}

Takahashi, Masahito ^{[2
,11
]}

Wada, Kanichiro ^{[2
,12
]}

Yamamoto, Naoya ^{[2
,13
]}

Shigematsu, Hideki ^{[2
,14
]}

Funaba, Masahiro ^{[2
,15
]}

Yasuda, Akimasa ^{[2
,16
]}

Kobayashi, Sho ^{[2
,3
]}

Ushirozako, Hiroki ^{[2
,3
]}

Tani, Toshikazu ^{[2
]}

Matsuyama, Yukihiro ^{[2
,3
]}

机构：

[1] Nagoya Univ, Grad Sch Med, Dept Orthoped Surg, 65 Tsurumai Showa Ward, Nagoya, Aichi, Japan

[2] Japanese Soc Spine Surg & Related Res, Tokyo, Japan

[3] Hamamatsu Univ, Sch Med, Dept Orthoped Surg, Hamamatsu, Shizuoka, Japan

[4] Kansai Med Univ, Dept Orthoped Surg, Osaka, Japan

[5] Tokyo Med & Dent Univ, Dept Orthoped Surg, Tokyo, Japan

[6] Kurume Univ, Dept Orthoped Surg, Kurume, Fukuoka, Japan

[7] Yamaguchi Rosai Hosp, Dept Orthoped Surg, Yamaguchi, Japan

[8] Hiroshima City Asa Citizens Hosp, Dept Orthoped Surg, Hiroshima, Japan

[9] Wakayama Med Univ, Dept Orthoped Surg, Wakayama, Japan

[10] Kyorin Univ, Dept Orthoped Surg, Tokyo, Japan

[11] Hirosaki Univ, Dept Orthoped Surg, Hirosaki, Aomori, Japan

[12] Tokyo Womens Med Univ, Dept Orthoped Surg, Tokyo, Japan

[13] Nara Med Univ, Dept Orthoped Surg, Nara, Japan

[14] Yamaguchi Univ, Dept Orthoped Surg, Yamaguchi, Japan

[15] Natl Def Med Coll, Dept Orthoped Surg, Tokorozawa, Saitama, Japan

[16] Kubokawa Hosp, Dept Orthoped Surg, Kochi, Japan

来源：

SPINE | 2021年 / 46卷 / 12期

关键词：

abductor hallucis; high risk spinal disease; lower limb muscle; prospective multicenter study; transcranial motor-evoked potentials; waveform change; POSTERIOR LONGITUDINAL LIGAMENT; CORD TUMOR; THORACIC OSSIFICATION; JAPANESE SOCIETY; CUTOFF AMPLITUDE; DECOMPRESSION; STIMULATION; MULTICENTER; RESECTION; DEFICITS;

D O I：

10.1097/BRS.0000000000003994

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Study Design. Prospective multicenter observational study. Objective. To evaluate transcranial motor-evoked potentials (Tc-MEPs) baseline characteristics of lower limb muscles and to determine the accuracy of Tc-MEPs monitoring based on preoperative motor status in surgery for high-risk spinal disease. Summary of Background Data. Neurological complications are potentially serious side effects in surgery for high-risk spine disease. Intraoperative spinal neuromonitoring (IONM) using Tc-MEPs waveforms can be used to identify neurologic deterioration, but cases with preoperative motor deficit tend to have poor waveform derivation. Methods. IONM was performed using Tc-MEPs for 949 patients in high-risk spinal surgery. A total of 4454 muscles in the lower extremities were chosen for monitoring. The baseline Tc-MEPs was recorded immediately after exposure of the spine. The derivation rate was defined as muscles detected/muscles prepared for monitoring. A preoperative neurological grade was assigned using the manual muscle test (MMT) score. Results. The 949 patients (mean age 52.5 +/- 23.3 yrs, 409 males [43%]) had cervical, thoracic, thoracolumbar, and lumbar lesions at rates of 32%, 40%, 26%, and 13%, respectively. Preoperative severe motor deficit (MMT <= 3) was present in 105 patients (11%), and thoracic ossification of the posterior longitudinal ligament (OPLL) was the most common disease in these patients. There were 32 patients (3%) with no detectable waveform in any muscles, and these cases had mostly thoracic lesions. Baseline Tc-MEPs responses were obtained from 3653/4454 muscles (82%). Specificity was significantly lower in the severe motor deficit group. Distal muscles had a higher waveform derivation rate, and the abductor hallucis (AH) muscle had the highest derivation rate, including in cases with preoperative severe motor deficit. Conclusion. In high-risk spinal surgery, Tc-MEPs collected with multi-channel monitoring had significantly lower specificity in cases with preoperative severe motor deficit. Distal muscles had a higher waveform derivation rate and the AH muscle had the highest rate, regardless of the severity of motor deficit preoperatively.

引用

页码：E694 / E700

页数：7

共 33 条

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